MBBS OSCE · emergency-toxicology
OSCE — Opioid Overdose
Eight-minute OSCE station on Opioid Overdose: focused history, examination priorities, investigations, emergency and definitive management.
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Brief (to candidate)
You will assess a patient with a presentation consistent with Opioid Overdose.
You have 8 minutes to take a focused history, outline examination, investigations, and management including red flags.
Clinical context
Opioid overdose produces the opioid (narcotic) triad: depressed consciousness/coma, respiratory depression (bradypnoea), and pinpoint pupils (miosis). Diagnosis is clinical plus response to naloxone. Resuscitate with bag-valve-mask ventilation and oxygen FIRST, then give naloxone (a competitive mu-opioid receptor antagonist) titrated to respiratory rate, not full alertness. Because naloxone's half-life (1 to 2 h) is shorter than most opioids, monitor for re-narcotisation for at least 2 to 4 h (24 to 48 h for methadone, sustained-release formulations, and fentanyl).
Candidate tasks
- Clarify onset, severity, associated features, and red-flag symptoms.
- State focused examination priorities.
- List first-line investigations and any named score/criteria.
- Give immediate resuscitation steps.
- Outline definitive management with doses/routes where standard.
- Name complications and disposition (ward / HDU / theatre / discharge safety-net).
- Mention one special-population modifier (pregnancy, child, elderly, CKD).
Examiner checklist
| Domain | Pass behaviours |
|---|---|
| Definition | Correct working diagnosis language |
| Assessment | Focused, prioritised, red flags sought |
| Investigations | Appropriate first-line + interpretation |
| Emergency care | ABC / time-critical actions first |
| Definitive care | Specific drugs/procedures, not generic phrases |
| Safety | Pinpoint pupils + respiratory depression + coma = opioid triad; give naloxone |
| Safety | Re-narcotisation 2 to 4 h after naloxone wears off (half-life shorter than the o |
| Safety | Fentanyl/synthetic opioids may need higher or repeated naloxone doses |
| Communication | Clear plan and safety-netting |
Model outline
Lead with the working diagnosis and life threats. Resuscitate before definitive tests when unstable. Use guideline-standard therapy with named agents and doses. Document escalation criteria and follow-up. A safe candidate is specific, structured, and never delays critical care for non-urgent imaging.